1. VJ Periyakoil Productionspresents

4. 250 miles from SLC VA Different time zone Adverse winter weather Elko, Nevada

5. Elko, Nevada • High mountain passes • Estimated veteran population in area = 4,000 • Enrolled veteran population = 211 • Agriculture and mining

6. Community Engagement

7. Elko County Community-Based Partnership Veteran Service Organizations (VFW, American Legion) Elko County Commission Great Basin College

8. Elko County Community-Based Partnership University of Nevada, Reno Nevada Health Systems

9. Town Hall Meetings • Community members • Veteran Service Organizations • Local medical providers: private and public • Local and state policy makers • Academic institutions • Salt Lake VA Health Care System leadership

10. Agenda Focus • Care for Veterans • Care for: • Uninsured • Underinsured • Medically-needy

11. “Negotiation with VA” • Proposal for a CBOC • Feasibility assessment • Evaluation of Telehealth as a delivery mechanism (home and facility based) • Identified gaps/barriers • Develop a joint business plan with community leadership

12. Shared Resource Allocation VA • Subject matter expertise • Curriculum development • Provider • Telehealth technology • CPRS • Office supplies/equipment • TV/DVD • Utilities Community • Space, IT, nurse faculty • Great Basin College • Furniture • University of Nevada • Marketing • VSOs, policy makers, local media, community • Draw Station, Exam Room • Local public healthcare clinic

13. Elko Telehealth Clinic

14. Evaluation • Improved access for original 211 enrollees • Increased unique veteran enrollment to >400 • Improved patient satisfaction

15. Evaluation • Expansion of services: • Mental Health • Specialty Consultations

16. Evaluation • Increased space (400 sq. ft. to 1200 sq. ft.) • Jobs in the community

17. Examples of Community Resources

18. National Organization of State Offices of Rural Health www.nosorh.org Mission Statement NOSORH promotes the capacity of state offices of rural health to improve health care in rural America through leadership development, advocacy, education, & partnerships. • Purpose • Support the development of state and community leadership for rural health • Facilitate partnerships at the national and state levels to enhance sharing and collaboration • Help communities promote a healthy rural America through enhanced access to quality healthcare services

19. State Community Resources • State Offices of Veteran Affairs • http://www.va.gov/statedva.htm • Rural Assistance Center • http://www.raconline.org/ • Rural Healthy People 2010 • http://www.srph.tamhsc.edu/centers/rhp2010/

20. VA Rural Health Resources Office of Rural Health http://vaww.ruralhealth.va.gov/

21. VA Rural Health Resources Veterans Rural Health Resource Centers Eastern Region (VISNs 1–10) Director: Ryan Lilly, ryan.lilly@va.gov Deputy Director: Alan West, PhD, alan.west@va.gov

22. VA Rural Health Resources Veterans Rural Health Resource Centers Central Region (VISNs 11–17, 23) Director: Peter Kaboli, MD, peter.kaboli@va.gov Deputy Director: Mary Charlton, PhD, nancy.daily@va.gov

23. VA Rural Health Resources Veterans Rural Health Resource Centers Western Region (VISNs 18–22) Director: Byron Bair, MD, byron.bair@va.gov Deputy Director: Nancy Dailey, MSN, RN-BC nancy.dailey@va.gov

24. For more information on rural veterans, contact: VJ Periyakoil, MD periyakoil@stanford.edu ruralhealth.stanford.edu